Radiotherapy versus no radiotherapy to the neo-breast following skin sparing mastectomy and immediate autologous free flap reconstruction for breast cancer. Patient reported and surgical outcomes at one year. A Mastectomy Reconstruction Outcome Consortium [MROC] sub-study
Menée à partir de données portant sur 125 patientes atteintes d'un cancer du sein traité entre 2012 et 2015, cette étude analyse les effets indésirables auto-rapportés d'une radiothérapie mammaire après mastectomie avec reconstruction immédiate autologue du sein par lambeau cutanéo-graisseux libre
Purpose : To determine if adjuvant radiotherapy [RT] is associated with adverse patient reported outcomes and surgical complications one year after skin sparing mastectomy and immediate autologous free flap reconstruction for breast cancer. Methods and Materials : We compared 24 domains of patient reported outcome measures one year after autologous reconstruction, between patients who received adjuvant RT and those who did not. A total of 125 patients who had surgery between 2012 and 2015 in our institution were included from the Mastectomy Reconstruction Outcomes Consortium [MROC] study database. Adjusted multivariable models were created incorporating RT technical data, age, cancer stage, estrogen receptor, chemotherapy, breast size, body mass index, and income to determine if RT was associated with outcomes. Results : One year after surgery EORTC QLQ BR23 Breast symptoms were significantly greater in 64 patients who received RT (eight point difference on 100-point ordinal scale, p<0.0001) versus 61 who did not on univariate and multivariate models. EORTC Arm symptoms (20-point difference on 100-point ordinal scale, p=0.0200) differed in univariable analysis but not in multivariable analysis. All other outcomes including Numerical Pain rating scale (NPRS), BREAST-Q (Post-operative Reconstruction Module), PROMIS-29, McGill Pain Questionnaire (MPQ-SF) score, Generalized Anxiety Disorder (GAD 7) and Patient Health Questionnaire (PHQ-9) were not statistically different between groups. Surgical complications were uncommon and did not differ by treatment. Conclusions : RT to the neo-breast compared to no RT following immediate autologous free flap reconstruction for breast cancer is well tolerated at one year following surgery despite patients undergoing RT also having a higher cancer stage and more intensive surgical and systemic treatment. Neo-breast symptoms are more common in patients receiving RT by EORTC QLQ BR23 but not by BREAST-Q. Patient reported results at one year after surgery suggest RT following immediate autologous free flap breast reconstruction is well tolerated.